MIDWEST MOBILE DENTISTRY LLC
NPI: 1417477985
· SAINT LOUIS, MO 63105
· Dental Clinic/Center
· NPI assigned 06/26/2017
$184K
Total Medicaid Paid
Provider Details
| Authorized Official | GRAHAM, JEREMY (OWNER/CEO) |
| NPI Enumeration Date | 06/26/2017 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
4,880 |
$143K |
| 2019 |
1,210 |
$42K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
1,229 |
1,207 |
$80K |
| D9310 |
|
1,228 |
1,208 |
$45K |
| D4355 |
|
445 |
436 |
$25K |
| D1110 |
Prophylaxis - adult |
456 |
447 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,588 |
417 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
447 |
438 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
430 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$154.00 |
| D0120 |
Periodic oral evaluation - established patient |
89 |
88 |
$24.00 |
| D0170 |
|
36 |
36 |
$0.00 |